Potential of unenhanced computed tomography as a screening tool for acute aortic syndromes

Aims Contrast-enhanced computed tomography (CE-CT) is the gold standard for diagnosing acute aortic syndromes ( AAS). Unenhanced computed tomography (unenhanced-CT) also provides specific findings for AAS; however, its diagnostic ability is not well discussed. This study aims to evaluate the potential of unenhanced-CT as an AAS screening tool. Methods and We retrospectively examined AAS patients who visited our hospital between 2011 and 2021 to validate the results diagnostic value of unenhanced-CT alone and along with the aortic dissection detection risk score (ADD-RS) plus D-dimer. Acute aortic syndrome was assessed as detectable using unenhanced-CT with any of the following findings: pericardial haemorrhage, high-attenuation haematoma, and displacement of intimal calcification or a flap. Of the 316 AAS cases, 292 (92%) were detectable with unenhanced-CT. Twenty-four (8%) cases undetectable with unenhanced-CT involved younger patients [median (interquartile range), 45 (42-51) years vs. 72 (63-80) years, P< 0.001] and patients more frequently complicated with a patent false lumen (79% vs. 42%, P< 0.001). Acute aortic syndrome-detection rate with unenhanced-CT increased with age, reaching 98% (276/282) in those >= 50 years of age and 100% (121/121) in those >= 75 years of age. With the ADD-RS plus D-dimer, there was only one AAS case undetectable with unenhanced-CT among patients >= 50 years of age, except for cases with the ADD-RS >= 1 plus D-dimer levels of >= 0.5 mu g/mL. Conclusion Acute aortic syndromes in younger patients and patients with a patent false lumen could be misdiagnosed with unenhanced-CT alone. The combination of the ADD-RS plus D-dimer and unenhanced-CT could minimize AAS misdiagnosis while avoiding over-testing with CE-CT. [GRAPHICS] .

Automated summary

This study evaluated the potential of unenhanced computed tomography (CT) as a screening tool for acute aortic syndromes (AAS), finding that misdiagnosis may occur in younger patients and those with a patent false lumen. The combination of the aortic dissection detection risk score (ADD-RS) plus D-dimer with unenhanced CT could help minimize misdiagnosis of AAS while avoiding over-testing with contrast-enhanced CT.